Provider Demographics
NPI:1841604006
Name:FAISON, WAYNE RAE (LPC)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:RAE
Last Name:FAISON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:RAE
Other - Last Name:FAISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:211 LARKWOOD LANE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-3834
Mailing Address - Country:US
Mailing Address - Phone:919-271-4710
Mailing Address - Fax:919-916-5391
Practice Address - Street 1:1103 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-3834
Practice Address - Country:US
Practice Address - Phone:919-271-4710
Practice Address - Fax:919-916-5391
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-16
Last Update Date:2017-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10835101YM0800X
NC20755101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)